Death Claim - Gbic.co.in

Chandigarh Ombudsman CentreCase No. : LIC/425/Ludhiana/24/07Sapna RaniVsLife Insurance Corporation of IndiaOrder dated: 30.3.07FACTS : Smt. Sapna Rani’s husband Late Shri. Nirmal Jeet Dhand had taken threepolicies bearing nos. 300494770, 300493932 and 300493933. The death claim filedunder the said policies was repudiated by the insurer on the ground of deceasedhaving withheld correct information regarding health at the time of effecting the policy.The complainant stated that her father-in-law and her husband had given correctinformation to the agent and the LIC officer about the admission in the hospital andwas operated thereafter. She stated that she was a witness to the above informationbeing given to the agent and LIC officer. Now they are not at fault. She urgedintervention of this forum in settlement of claims in her favour under the said policies.FINDINGS : The insurer informed that the DLA was operated for Pneumo Thorax asper the CR No. 3965 dated 3.11.05. The DLA himself informed the doctor about acutepain in chest and breathlessness and he remained in the hospital from 3.11.05 to21.11.05. In view of the above report it is clear that the DLA suffered from heartproblem before the date of proposal and it was also in the knowledge of the DLA whichhe did not disclose it in the proposal form. Had he disclosed it in the proposal form, thecase would have been underwritten after due consultation with the DMR. Hence, firstpart of section 45 of Insurance Act, 1938 became operative and the claim wasaccordingly repudiated.DECISION : Held that in view of the clarifications given by the insurer andcorroborative evidence on record, the repudiation of the claim by the insurer was inorder and the same was upheld. The complaint was dismissed.Chandigarh Ombudsman CentreCase No. : HDFC/397/Mumbai/Hissar/21/07SukhjivVsHDFC Standard Life Insurance Co. Ltd.Order dated: 29.3.07FACTS : Ms. Sukhjiv’s husband Late Shri Rohit Joshi had purchased a policy bearingno. 10403372 with DOC 30.10.05 for SA of Rs. 5 lakhs under Term Assurance Policy.Her husband expired on 20.5.06 due to sudden heart problem. The insurer wronglyrepudiated the claim considering the cause of death as suicide. She stated that shehas no source of livelihood and total liability on her old parents who also have nosource of income. The PMR did not mention that traces of poison were found in thebody. The cause of death was shown as cardio pulmonary oedema. She contended thatthis was not a case of suicide but natural death.FINDINGS : The insurer informed vide letter dated 6.3.07 that the LA Shri Rohit Joshiwas issued a Term Assurance Policy on 24.10.05. The LA expired on 20.5.06 after thepolicy had been in force for less than 7 months. The LA was 34 years of age andprobably this was the only insurance policy he had. The investigations revealed that LAhad committed suicide and his body was found near a field. The father of LA hadreported to the Police that LA had committed suicide and that his body was found neara field, away from the residence. The death report by the police also stated that the LAmay have committed suicide by consuming poison. The Chemical Analysis Report